CHIP Pharmacy & Drugs

CHIP Pharmacy

FirstCare CHIP members can access prescriptions through any pharmacy that is contracted with the Navitus Health Solutions. Navitus administers prescription benefits for FirstCare CHIP Members. For pharmacy questions, contact Customer Service at 1-877-639-2447.

Find Your Pharmacy

You can view your pharmacy directory using the links below:

• Lubbock Pharmacy Directory PDF
• Lubbock Online Directory

Formulary

FirstCare uses the state mandated CHIP formulary. The formulary is available on the Texas Medicaid Drug Vendor Drug Program website.

The Texas CHIP Formulary is available in paper form without charge. To request a copy, please call FirstCare CHIP Customer Service at 1-877-639-2447.

Prior Authorizations

To obtain a prior authorization, providers should call Navitus at 1-877-908-6023. For a listing of clinical edits implemented by FirstCare please click here, and for access to FirstCare's prior authorization forms please click here.

• Download the State of Texas Standard Prior Authorization Form.
• If your doctor cannot be reached to approve a prescription, you can get a three-day emergency supply of your medication. Call FirstCare at 1-806-784-4300 for help with your medications and refills.

Member Forms

Prescription Mail Order Form
Prescription Mail Order Form (Spanish)

Member Notices

• 2023-24 RSV Season Schedule
• Deadline for Draft Policy Review Due Oct. 5, 2023
• 2023-24 RSV Season, Synagis Prior Authorization Begin Oct. 2, 2023, for Lower South Texas
• July 2023 Preferred Drug List Revised Aug. 30, 2023
• HHSC To Implement Clinical Prior Authorizations For Fee-For-Service on Oct. 31, 2023
• Clinical Prior Authorization Assistance Chart Now Available
• Summary of July 2023 Drug Utilization Review Board Meeting Now Available
• July 2023 NDC-to-HCPCS Crosswalk Now Available for Clinician-Administered Drug Processing
• HHSC Updates Clinical Prior Authorizations Criteria Guides
• April 2023 Preferred Drug List Decisions
• Pharmacy Education Information and Opportunities
• Agenda Available for Upcoming July Drug Utilization Review Board Meeting
• Clinical Prior Authorizations Updates and Implementations for Fee-For-Service
• Semi-annual Medicaid Preferred Drug List Update Coming July 27, 2023
• MCO Search Now Available
• Removal of Quantity Limits for Hepatitis C Medications, Including Mavyret Preferred Hepatitis C Treatment
• Revised VDP Manuals Available
• Change in Preferred Drug List Status for the Smoking Cessation Drug Class Effective May 16, 2023
• HHSC to Implement Clinical Prior Authorization for Gattex on June 6, 2023
• HHSC to Implement Clinical Prior Authorization for Antimigraine Agents-Ergot Derivatives on June 6, 2023
• HHSC to Revise Qulipta Criteria for Clinical Prior Authorization on June 27, 2023
• HHSC to Implement Sotyktu Criteria in Cytokine and CAM Antagonists Clinical Prior Authorization on July 27, 2023
• HHSC to Implement Pulmonary Hypertension Agents Clinical Prior Authorization on July 27, 2023
• Preferred Mavyret for Hepatitis C Infection Treatment and Change to Quantity Limit for Hepatitis C Medications

  05/11/2023 Background:

  HHSC published the notice “Preferred Mavyret for Hepatitis C Infection Treatment and Change to Quantity Limit for Hepatitis C Medications” on May 1, 2023

  Key Details:

  This update is to clarify the following notice regarding the quantity limit change for Hepatitis C infection treatment. The quantity limit change in this notice applies to all Hepatitis C DAA medications, not just the NDCs listed in the table below

  Quantity Limit Change

  HHSC intends this initiative to increase awareness, screening, diagnosis, and treatment for Medicaid clients. HHSC will help improve access and adherence by allowing prescribers to write prescriptions for the entire course of therapy so clients will no longer need to request additional refills throughout their treatment duration. Prescribers may choose to write a prescription for the entire treatment cycle or have the client return for further testing if warranted. This change applies to all Hepatitis C DAA medications

  By May 25, 2023, MCOs must update pharmacy quantity supply limits and maximum day supply coverage on DAA medications to allow access to the entire course of therapy. Prescribers may identify some clients needing to take the medication longer than others. MCOs may allow longer treatment duration upon prescriber request. MCOs must inform their providers and members of this change

  Reminder

  All Medicaid clients are eligible for DAA treatment with the primary preferred agent regardless of the client’s METAVIR fibrosis score, and prior authorization is not required. Any enrolled Medicaid provider can prescribe the preferred drug, and HHSC does not require a drug screening. The table below summarizes the national drug codes (NDCs) impacted by the PDL change:

  Drug Name	NDC	Jan 1, 2023 PDL status
  Mavyret	00074260028 00074262528	Preferred
  Epclusa	61958220101 61958220301 61958220401 61958220402 61958220501 61958220502	Non-Preferred
  Vosevi	61958240101	Non-Preferred

  HHSC published an update to the Texas Medicaid Preferred Drug List (PDL) on Jan. 1, 2023, designating the preferred and non-preferred options for DAA treatment. HHSC also included the changes in the daily PDL file delivered to managed care plans via TXMedConnect. PDL statuses were future-dated to reflect the Jan. 1 changes

  HHSC did not change the PDL status for all other non-preferred DAA drugs currently on the formulary. For any non-preferred DAA drugs, HHSC will continue to apply PDL prior authorization criteria for all Medicaid clients, both fee-for-service and managed care

  HHSC asks MCOs to continue to remind their providers and members regarding the availability of Hepatitis C treatment coverage

  Contact: vdp-operations@hhsc.state.tx.us

• HHSC Removed Monovalent Moderna and Pfizer-BioNTech COVID-19 Vaccines From Formulary on April 21, 2023
• HHSC to Update Hereditary Angioedema Clinical Prior Authorization For Fee-For-Service on May 23, 2023.
• HHSC to Update Anxiolytics and Sedative-Hypnotics Clinical Prior Authorization For Fee-For-Service on June 22, 2023
• Jan. 2023 Preferred Drug List Decisions Now Available
• Update to "HHSC To Implement Clinical Prior Authorizations For Fee-For-Service"
• Pharmacy Email Addresses Must Be Current in PEMS
• Clinical Prior Authorization Assistance Chart Now Available
• HHSC to Revise Opiate/Benzodiazepine/Muscle Relaxant Combinations Prior Authorization
• Summary of April 2023 Drug Utilization Review Board Meeting Now Available
• HHSC To Update Opioid Product Information in Clinical Prior Authorizations for Medicaid Fee-for-Service
• CSHCN To Remove Multiple Drugs From Formulary on June 1, 2023
• Age Expansion Indication for Cibinqo Clinical Prior Authorization Criteria Effective May 31, 2023
• Update to Livmarli Clinical Prior Authorization Criteria Effective May 30, 2023
• Makena Products No Longer Covered As Of April 7, 2023
• March 2023 Specialty Drug List Available
• Hereditary Angioedema Agents Clinical Prior Authorization Effective for Medicaid Fee-for-Service on April 11, 2023
• HHSC to Implement Enzymes Clinical Prior Authorization for Medicaid Fee-for-Service on April 18, 2023
• Temporary Change in PDL Status for the Neuropathic Pain Drug Class Effective April 3, 2023
• Pharmacy Education Information and Opportunities
• Revisions of Antimigraine Agents (Triptans) Clinical Prior Authorization Criteria Scheduled for April 5, 2023 (Revised)
• Implementation of Inhaled Antibiotics Clinical Prior Authorization for Medicaid Fee-For-Service Set for May 2, 2023
• Clinical Prior Authorization Criteria for Calcitonin Gene-Related Peptide Receptor Antagonists Effective April 4, 2023
• 2022-23 RSV Season Schedule
• Revision of Olumiant Clinical Prior Authorization Criteria Scheduled for March 27, 2023
• Clinical Prior Authorization Assistance Chart Now Available
• Changes to Lovaza Clinical Prior Authorization Scheduled for March 21, 2023
• Changes in Hepatitis C Treatment Coverage for Medicaid Clients Begins Jan. 1, 2023
• NDC Requirements for the Submission of Clinician-Administered Drug Claims
• Hepatitis C Treatment Coverage and PDL Update Scheduled for Sept. 1, 2022